First-Ever Federal Data Release Shows Short Supply Of Critical Care Beds In Oregon
A first-ever release of detailed data on COVID-19 hospital capacity and patients indicates that hospitals across the country are quickly reaching their maximum ability to treat the most critically ill patients.
That holds true in Oregon, which has regional systems for sharing hospital resources, with patients sometimes shifted to facilities in large metro areas, such as Portland, for treatment. But even those facilities could run out of critical care space if the cases continue to rise, the data indicate.
In the past month, the number of Oregon patients with COVID-19 or suspected of having the disease more than doubled from 234 on Nov. 2 to 622 on Dec. 7, according to the Oregon Health Authority. The agency said Tuesday that 553 patients with COVID-19 or suspected of being infected were hospitalized with 127 in intensive care beds.
The Oregon Health Authority releases daily updates on hospital capacity but those figures are aggregated at the county level. The federal release drills down to the local level.
The release follows a decision last March by the Trump administration to centralize hospital data related to COVID-19 patients. It asked facilities to issue detailed daily reports to the U.S. Department of Health and Human Services. The agency shared the data internally but on Monday, for the first time, it released the data publicly. The release gives the public an inside look at the health care system’s capacity at a time when cases are mounting and hospitals are reaching a critical point in their capacity.
The data represent averages during the week beginning on Friday, Nov. 27. They show adult intensive care units even in larger hospitals could quickly reach capacity even if their overall patient population only includes a relatively small percentage of COVID-19 patients.
In the Portland metro area, Legacy Emanuel Medical Center’s 52-bed adult intensive care unit was the most full, with 89% of beds taken on average the week of Nov. 27. But only 15% of the beds were COVID-19 patients. Legacy spokesman Brian Terrett said the company’s six hospitals in Oregon and Southwest Washington have faced no major problems managing COVID-19 patients. He said each hospital decides whether to postpone elective procedures and by how much. Suspending them can lessen demand for ICU beds.
“Legacy also has developed surge plans for each of its six campuses to deal with any massive increase in patients,” Terrett said.
Legacy Emanuel Medical Center and Oregon Health & Science University in Portland are both level 1 trauma centers, which often have intensive care units filled to 80% capacity. The week of Nov. 27 on average OHSU’s ICU was at 76% capacity, the data show, with COVID patients accounting for 16% of adult ICU beds. OHSU, the biggest hospital in the state, had on average the highest number of diagnosed or suspected COVID-19 cases -- 13.
In comparison, Providence Portland Medical Center’s intensive care usage averaged 88% the week of Nov. 27. But less than third of the beds were taken by patients with COVID-19, or patients suspected of having the disease.
Outside the Portland area, some large hospitals were also close to capacity the week of Nov. 27. Asante Rogue Regional Medical Center in Medford, for example, averaged nearly 89% capacity in its 44-bed adult intensive care unit. Just 23% of the unit’s patients had COVID-19.
Hospitals have adopted various strategies to free up beds. They range from turning a conference hall into a new unit at OHSU, to shuffling patients among hospitals at St. Charles Health System based in Bend, to cancelling non-urgent procedures.
The data show how quickly a hospital’s intensive care unit can become overwhelmed by a mix of COVID-19 cases and other patients. The data highlight the concerns of public health officials who have repeatedly urged Oregonians to wear face masks outside their home, keep at least six feet away from those not in their household and limit the size of gatherings to avoid spreading the disease. To curb gatherings, the state has largely shut indoor restaurant dining and bars, along with most gyms and similar facilities.
Research has shown that people without symptoms can spread the novel coronavirus. Though most people recover, the virus can be deadly for those with compromised immune systems, including the elderly.
About 20% of the 5,012 Oregonians hospitalized with COVID-19 in the course of the pandemic have received treatment in intensive care, according to Oregon Health Authority data. That suggests about 1,026 Oregonians have filled intensive care beds since March due to the pandemic.
The federal agency has asked hospitals to report detailed data, including the overall number of beds per facility; inpatient occupancy; intensive care occupancy; the number of hospitalized COVID-19 patients, both adults and children; the previous day’s COVID-19 deaths and admissions; the number of COVID-19 patients in emergency departments and overflow areas; the use and supplies of the antiviral drug remdesivir; current and anticipated shortage of critical care personnel; and supplies of personal protective gear like N95 and head respirators, eye protection, gowns, gloves; and COVID-19 testing swabs. Not all of these data were released.
The public release shows what the situation during one week at hospitals across the country, including 61 in Oregon. They include large metro-area hospitals with more than 300 beds -- like OHSU or Sacred Heart Medical Center Riverbend in Springfield -- to small, regional hospitals with less than a dozen beds, including Harney District Hospital in Harney and St. Alphonsus Medical Center in Baker City. Hospitals with fewer than four staffed intensive care beds are not included in the data.
The data show wide variances in intensive care capacity among hospitals in the Portland metro area in late November. Legacy Good Samaritan in Portland had 21% of its adult intensive care beds filled with COVID-19 patients but was at an overall capacity of just 54%.
Meanwhile, Adventist Health in Portland had 21% of its intensive care beds filled with COVID-19 patients, but averaged 75% capacity, federal data show.
Other hospitals have more room in intensive care units.
Kaiser Sunnyside Medical Center in Clackamas had 27% of its intensive care beds filled with COVID-19 patients, but was only at 60% capacity.
Overall, COVID-19 has killed 1,080 people in Oregon and 87,082 people have tested positive as of Tuesday. The Oregon Health Authority reported 36 deaths on Tuesday, the highest number of fatalities in one day so far. New cases of COVID-19 now routinely exceed 1,000 day and state modeling suggests the numbers likely will rise to more than 2,000 cases a day by Christmas.
The health authority on Monday reported 565 people hospitalized with COVID-19, an increase of 19 from one day earlier. As of Monday, Oregon had 120 COVID-19 patients in intensive care unit beds, seven more than Sunday.
The federal data release coincides with the publication on Tuesday by the Oregon Health Authority of guidelines for health care facilities to follow in the event that ICU beds and other resources run short. The principles, the result of a collaboration between state health officials and community groups, aim to ensure that minorities, people with disabilities and the elderly are not left out if providers are forced to decide who takes priority for an intensive care bed or a ventilator, for example.
The principles emphasize non-discrimination, equity among ethnicities and demographic groups in the allocation of resources, making decisions based on patients and transparency in the process. The agency said that a patient’s condition, life expectancy, quality of life or use of oxygen or other devices should not be taken into account.
That goes against systems adopted elsewhere that consider expected longevity in triage decisions.
Oregon State Sen. Sara Gelser, who represents Corvallis and Albany and is a longtime advocate for people with disabilities, said the guidance marks a major step forward.
“The principles position Oregon as a national leader in health care justice work, providing a model to other leaders doing this work across the county,” Gelser said in a statement. “This is only the start of the discussion.”
The Oregon Health Authority advised hospitals to create a scoring system to use when allocating scarce resources to guard against any discriminatory attitudes of providers or other health care personnel.
“No patient should be denied care due to their disability or assumptions about how long they are expected to live with their existing health conditions,” Emily Cooper, legal director of Disability Rights Oregon, said in a statement. “We look forward to continuing to work with the state as they work toward developing longer-term guidance.”
The U.S. Department of Health and Human Services plans weekly updates of hospital capacity data to give the public a look at what's happening in their area.
Jason Fenton was instrumental in the reporting of this story.